Elevated high-sensitivity c-reactive protein levels predict poor outcomes among patients with acute cardioembolic stroke

Abstract

Background: High-sensitivity C-reactive protein (hs-CRP) as a prognostic factor of stroke has been proposed and studied. However, the relationship between hs-CRP levels and outcomes among patients with cardioembolic stroke (CES) remains unclear. This study aimed to evaluate the association between hs-CRP levels in the acute phase of CES and poor patient outcomes. Methods: We recruited 478 patients with first-onset CES. Hs-CRP and other biochemical markers were measured within 24 h after admission. Hs-CRP levels were grouped into quartiles (<2.31, 2.31 to <6.09, 6.09 to <22.30, and ≥22.30 mg/L). Stroke severity was assessed using the modified Rankin scale (mRS), with mRS scores of 0 to 2 classified as a good outcome, and scores of 3 to 6 as a poor outcome. Composite endpoints included poor outcomes, vascular death, myocardial infarction (MI), and recurrent stroke (ischemic or hemorrhagic). At 3-month and 1-year follow-ups, we used multivariate logistic regression analysis to assess the relationship between baseline hs-CRP levels, mRS scores, and composite endpoints. Results: Among 478 patients with CES, the median hs-CRP level was 6.09 mg/L. Regarding the primary outcome, we found that hs-CRP levels ≥22.30 mg/L were positively correlated with poor outcomes at the 3-month and 1-year follow-ups [odds ratio (OR): 3.862, 95% confidence interval (CI): (1.675–8.904), P=0.002; and OR: 5.479, 95% CI: (1.692–17.744), P=0.005, respectively]. The secondary outcomes paralleled the results of the primary outcomes at the 3-month and 1-year follow-ups [OR: 3.381, 95% CI: (1.620–7.058), P=0.001; and OR: 3.181, 95% CI: (1.475–6.860), P=0.003, respectively]. Conclusions: Elevated hs-CRP in patients with CES is an independent predictor of poor outcomes; however, this association is particularly evident when hs-CRP ≥22.30 mg/L.